TRICARE FEES OVERSEAS:
U.S. Military retirees and dependents of both
>> active duty and retiree members' of the U.S. Militar residing outside
of
>> the United States will soon be experiencing increased out of pocket
>> expense of up to double or more for using Tricare. This is happening in
>> spite of Congress' continued refusal in past years and their refusal in
>> MAY 08 to allow DoD's proposed Tricare fee increases requested in the
>> 2009
>> NDAA. All active duty military, retirees and dependents are covered by
>> Tricare for their health care. Tricare is a Department of Defense
Health
>> Insurance Program developed and authorized by Congress. Military
member's
>> dependents, retirees and their dependents living in foreign countries
>> that
>> are covered under the Tricare Standard Program will soon have a new
>> "country specific index" applied to all medical claims they
submit to
>> Tricare. This new index is a product of the World Bank's survey of the
>> average cost of goods and services in a specific country and resulted
in
>> the development of a percentage factor that reflects what amount of
goods
>> and services $1.00 would buy in the foreign currency. Unfortunately,
this
>> survey was taken in 2005, prior to the decline of the U.S. dollar
>> overseas
>> and does not accurately reflect the cost of those goods and services in
>> today's dollar. Worst yet, since this survey results are an average of
>> the
>> cost of goods and services, it mixes private health care cost with the
>> foreign government health care cost, (which are normally provided free
or
>> at a nominal fee, much like Medicaid).
>>
>> The program is due to take effect in AUG 08 and
will be phased in
>> using a higher allowed percentage for the first year and then the World
>> Bank's percentage starting on 1 MAR 09. The implementation of this
>> program
>> is being done under the DOD's rule making authority; however, it in
>> effect
>> skirts the U.S. Congress' directions which established a 25% co-pay for
>> Tricare Standard beneficiaries. DoD has apparently rationalized they
can
>> do this through the use of survey data from the World Bank. Data that
>> even
>> the World Bank states, in it's handbook on this survey, must take into
>> consideration the foreign exchange rate, (and presumably the inflation
>> rate), for a specific country at the time of making use of their data.
>> The
>> DOD has ignored that part of the study handbook, and is going to ignore
>> the vast difference in health care cost in rural vs. urban settings and
>> private vs. government health care. The program is scheduled to start
in
>> the Philippines and Panama first with the intent to later make it the
>> standard for all foreign countries where Tricare has beneficiaries
>> residing. An example of how this program will affect the pocket books
of
>> the dependents and retirees in the Philippines is;
>> . A Beneficiary is admitted to a Hospital in Manila for a coronary
bypass
>> and is hospitalized for 10 days.
>> . The hospitals' legitimate charges, (the charges that the same
procedure
>> would cost a Philippine citizen), is $11,200.
>> . Tricare will only allow $6971 for this procedure based on the country
>> specific index.
>> . Thus, the beneficiary must pay the hospital the additional $4,229
that
>> Tricare will not pay.
>> . Tricare will only reimburse the beneficiary 75% of the allowed
amount.
>> The beneficiary is mandated by Federal statute to pay 25% of what ever
>> Tricare pays. Thus, only $5,228.25 of the$11,200 will be at government
>> expense.
>> . The beneficiary will pay the outstanding hospital bill of $4,229 plus
>> the co-pay of $1,742.75 for a total of $5,971.75 (or 53.32% of the
total
>> hospital bill).
>>
>> Other examples for out-patient care have shown a beneficiary cost of
>> 60-70-80% of the total amount of the bill. And then comes the kicker.
In
>> most third world countries, such as the Philippines, the patient must
pay
>> the hospital bill and doctors/laboratory bills in full prior to
discharge
>> from the hospital or prior to receiving medical care. Some hospitals
>> require a deposit of 110% of the estimated hospital bill prior to
>> admission. In the Philippines, unlike the U.S., a hospital is not
>> required
>> to admit a patient or treat a patient without getting paid for the
>> medical
>> care given. Using the above example there are very few Tricare users
who
>> could come up with $11,200 within a day in order to get treated for a
>> life
>> threatening medical condition.
>>
>> DOD has refused to use a prevailing rate system
for the Philippines,
>> even though this is the manner in which they determine allowable
charges
>> in the U.S., (and the U.S. rates are adjusted by zip codes and
localities
>> to account for the differences in health care cost in different parts
of
>> the U.S.). This and the use of a new country specific index will force
>> overseas dependents and retirees to shoulder a higher percentage of
their
>> health care cost than is required of their counterparts in the U.S.
>> Speculation as to why this is happening is:
>> . DOD does not think anyone will notice. They need to find funds to
help
>> with the Iraq war cost. They know, due to all the newspaper articles
>> concerning poor treatment of active duty and retired military in U.S.,
>> that they could not extract the savings from U.S. military health
system
>> in the U.S. But the service members and retirees overseas don't
normally
>> make the news, so why not get the dollars from them.
>> . Though intentional misuse of data from the World Bank they can ignore
>> the exchange rate, inflation rate and take an average cost analysis to
>> derive a reduction in benefits to the overseas retiree and dependent
>> community.
>> . By reducing future overseas reimbursements DoD can recoup losses due
to
>> Tricare fraud intensified by inaction of their overseas regional
>> contractor WPS. (i.e. $100 million over 6 years by Health Visions).
>>
>> Government should treat equally all active and retired military members
>> who served their country honorably. If you feel to not do so is
wrong
>> you
>> are encouraged to contact your Senate and House representatives and
tell
>> them to stop DOD from eroding our overseas military community's
benefits.
>> Attachment 3 to this Bulletin contains a suggested letter for mailing
to
>> one or more of your Congressional representatives. Attachment 4
contains
>> extensive background on how we would up in this situation.
Congressional
>> contact information can be obtained from
>> https://forms.house.gov/wyr/welcome.shtml
. [Source: Various 9 Jun 08